Severe pph (nearly 3 litres) and undiagnosed placenta previa. .. am I mad to even consider another?

[Fairylea]

As title really. I'm curious if anyone has been through similar and whether you decided to go again or not. ..

My first child (dd now aged 11) was a terrible long labour over 3 days ending in ventouse and a problematic episiotomy. So with ds now 2 I fought tooth and nail to get an elective c section.... which I got in the end and it was lucky I did as when they began they realised I had totally undiagnosed placenta previa (despite a late scan at 36 weeks for unrelated issues). I lost nearly 3 litres of blood and had 2 blood transfusions.

For a while there was total panic as they seemed unable to stop the bleeding.

My dh and I are now taking of perhaps trying for another baby and I really can't decide if we're being irresponsible to even consider it? I thought the risks of placenta previa and blood loss rise with every pregnancy?

Was mine particularly worse in terms of panic and wait for transfusion because it was unexpected? If you had it and they knew was it as scary?

On the one hand I'm terrified and on the other I've heard of several people who have gone through similar and tried for another without a second thought. ....!

Head is spinning and all opinions appreciated. Thanks very much!

Placenta Praevia isn't an inherited thing so if you had it once you don't necessarily have it again. I had pp stage 4 with dc1 and it was only diagnosed at week 30 when I had contractions.

Dc2 was 2.5 years later and was a vbac. Good luck.

Thank you... that's inspiring. Thanks for sharing.

I thought once you'd had previa once your chances of having it again were increased?

No it's not. It's where your placenta is located and that can be anterior or posterior, and of course where it lies depends on your baby and how it develops through the growth period.

My pp was posterior which was good because otherwise there would have been massive bleeding when they cut through (which sounds like what happened to you)., my vbac, the placenta was anterior.

Most placentas move and there are various stages of pp (1-4). So a lot of the time unless it's a grade 3/4 they won't really give you a c-section (in this country!!!).

Mine was stage 4. The consultant jokingly (!) said to me afterwards thank goodness I had been booked in for a c section anyway as there would have been no way I could have given birth naturally (which was fine by me as I didn't plan to anyway)!

I didn't realise that about the placenta position changing so much. So it really is pot luck then....

Hmmm. Still scared. More of the pph I think. I found it very frightening that they didn't seem to be able to control the bleeding for quite a while. I'm scared I might die if it happens again.

Once you have a c section your chance is increased. Number of pregnancies increases likelihood too (something to do with placenta having to attach in a different place in the uterus each time).

Good info from Royal College of Obstetricians here.

Previous pph increases risk of having another pph during c section or vbac regardless of whether praevia is present.

Risk of praevia with accreta is something to consider. I had a low lying placenta with dc2 after one c section that moved up. I had grade 4 praevia with dc3 after two previous c sections that developed into perceta where my placenta grew into my bladder. I lost my total blood volume 6-7 litres and had an emergency hysterectomy to save my life. It was known about in advance, they had blood ready, I had a top consultant at a top maternity hospital, but they still almost lost me. Amanda Holden had this, you can google her story too.

Frankly I'd be more scared about the bleeding. Ironically with my first child it went swimmingly well and no mega bleeding beyond the norm etc. with the vbac, I had 3 pints of blood transfusion - coz they missed how much I'd bled (wtf?!) and didn't realise. I did also faint whilst going to visit my child in special care!!

I'd speak to the consultant when you are preg and see what they say. A friend just had baby 2 recently and it was a planned c section after a horrid experience and thrombosis etcetera with first baby 6 years ago. They said if she ever had a 3rd it would just be a c section again. No questions.

Thank you very much Anotherstitch, sorry to hear of your experience. Very scary. I will read those links. Maybe I should just count my blessings and stop at the 2 dc I have.... hmmm. So much to consider.

Cross posted with NK. Thanks for the reply - how on earth did they miss you bleeding?! Poor you. . The bleeding scares me the most too. If I did have another I would go straight for a c section - I wouldn't ever want to go for a vaginal birth even if it was an option because of the traumatic time I had having dd.

I had a similar experience in that I lost most of my blood, needed a lot of transfusions and ended up in intensive care due to it. I would have had a hysterectomy if it wasn't for their clever "balloon" technique working. AnotherStitch - I've not actually spoken to someone else whose had this, its interesting to see your post. But having said that I still get panicky thinking about how close I came.

I honestly couldn't risk birth again because of it.

The consultant DID say I shouldn't let it put me off having a baby if I wanted to BUT they would heavily monitor me/ tons of intervention at the birth stage but they'd far far rather a natural birth as a c section woudl have a higher risk of pph.

Its one of the highest causes of maternal death, although of course mainly in less developed countries, but I still thank my lucky stars I was near a major hospital.

Sorry to hear of your experience journeying, it was very scary if I hadn't had a hysterectomy I was due to get sterilised as there was no way I was risking another pregnancy.

Something also to consider is even with just praevia you can bleed on and off throughout the pregnancy. I was kept in hospital for two months prior to delivery and the majority of long term inpatients on my ward were ladies with praevia. It had a massive impact on my then 4 year old dd1 and 18 month old dd2. Dd2 in particular has taken the last 6 months to recover emotionally from that time. The stress of bleeding and possible premature delivery is also something to consider.

I still get flashbacks. I have had some counselling but obviously not enough!

OP - I think you can ask for a consultant appointment prior to pregnancy to talk through risks/ what they would recommend/do to help in labour etc. if that would be helpful.

I had PPH of >2l after Ds2, causing me to collapse, emergency surgery, blood transfusion. It was an extremely scary experience, perhaps more so for DH as I was pretty out of it.
We did decide to go for Dc3, was under consultant care. Risk of recurrence is 3x greater than baseline of 5-8%, I didn't think 20% ish sounded that bad, from just talking about it generally had assumed it was almost certain to recur? Plan was consultant led birth ( in delivery suite rather than MLU) with I/v catheter sited and cross-matched blood on standby, active management of 3rd stage. In the event DD arrived in 80 mins, before catheter put in, but I only lost 150ml blood. I was very anxious about it during the pregnancy and it did overshadow DDs arrival as we were both anxious about bleeding immediately after the birth.
No experience of PP but agree with the others than talking through the risks in your particular situation before TTC sounds like the way to go.

Me too journeying.

Might be worth having a review of your notes with a consultant as others have said.

There is a good comparison of risks for c section vs vbac in the NICE c section guidance which I found useful for planning my attempted vbac with dc2. If you have had previous vaginal delivery followed by elcs, you have higher chance of success for vbac.

Thanks - seems like maybe getting in touch with my consultant and asking a lot of questions might be a good idea.

There was quite a delay between me being in recovery and getting the blood I needed which made me feel a lot worse than I did. Maybe if they suspect I might need a transfusion they might get blood ready in case? I'm not sure.

Thanks re the vbac stuff but I would never want another vaginal birth. Ever. I was absolutely traumatised by my first birth (which is why I went for a c section the second time) and any subsequent pregnancies I have (if I do....) I would have a section for.

Very interesting replies and lots to consider.

I think from what my consultant said that a c section carries a higher risk of PPH. I completely understand not wanting another v birth though.

I suspect they would have everything ready if they thought you were at risk - which in my mind tried to make me think "it woudln't be like last time" as they would be prepared.

Definitely see consultant with a prepared list, include you'd only have a c section and previous history etc...

Good luck x

Totally understand about not wanting another v birth too, both of my attempts ended in stuck babies.

The guidance I posted has lots of info on best practice for c sections and clearly outlines risks so still worth a read for material to discuss with consultant.